Provider Demographics
NPI:1053847921
Name:NICOLINI, JULIA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:NICOLINI
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2623 W CHICAGO AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8180
Mailing Address - Country:US
Mailing Address - Phone:574-993-7992
Mailing Address - Fax:
Practice Address - Street 1:1943 S MAY ST
Practice Address - Street 2:1F
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3359
Practice Address - Country:US
Practice Address - Phone:312-579-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
IL164005374133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL164005374Medicaid